Eyelid surgery linked to nerve recovery in patients with neurotrophic keratopathy

In a small case series, comprehensive eyelid surgery in patients preganglionic facial nerve palsy complicated by preganglionic trigeminal nerve palsy was associated with improvement in corneal sensation and trophic function.

The series included 3 patients with longstanding preganglionic facial nerve palsy and preganglionic trigeminal nerve palsy, with a mean disease duration of 28.3 months. All patients had eyelid abnormalities related to facial nerve palsy and underwent comprehensive eyelid surgery to address these sequelae.

At presentation, 2 of the 3 patients had complete absence of corneal sensation, and the third had reduced sensation. All cases showed absent trophic nerve function. Corneal sub-basal nerve plexus density was measured with in vivo confocal microscopy in 1 patient.

Following surgery, markers of trophic function began to improve after a mean of 19 days. Recovery of corneal sensation was observed later, with an average onset of 10 months postoperatively across the 3 patients. In the patient who underwent confocal imaging, corneal sub-basal nerve plexus nearly doubled 6 months after surgery.

Reference
Moledina M, Lim C, Dua HS, et al. Recovery of corneal sensation following eyelid surgery for neurotrophic keratopathy and preganglionic facial palsy. Br J Ophthalmol. 2026;bjo-2025-328162. doi: 10.1136/bjo-2025-328162. Epub ahead of print. PMID: 41667221.